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Vancouver program provides ‘window of opportunity’ to addiction treatment

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VANCOUVER — A Vancouver emergency department has become the first in Canada to give overdose patients take-away packs of medication aimed at warding off withdrawal symptoms and getting them into treatment to prevent deaths from tainted opioids.

Dr. Andrew Kestler, a co-lead of the program at St. Paul’s Hospital, said patients get a three-day supply of Suboxone and easy-to-understand instructions from a nurse before they’re discharged.

The idea is to prevent barriers to treatment because many patients are unable to get a prescription filled at a pharmacy after they leave the hospital, Kestler said Wednesday, adding severe physical and emotional withdrawal symptoms can make it impossible for people to seek help.

“We know that of people who have died of an overdose in British Columbia, over 50 per cent of those had visited an emergency department in the last year before their death,” he said.

Five women and three men have so far been given the medication in the emergency department, Kestler said.

“We’re hoping to translate our experience at St. Paul’s to the rest of the province and the rest of the country.”

Patients from the hospital can also access a clinic in the same building so they can be connected with services in the community before being followed up by an overdose outreach team that can link them to a doctor.

The two-year pilot project will be evaluated by the BC Centre on Substance Use in the province, which has the highest number of overdose deaths in Canada.

Mark Haggerty, a peer support worker at the Rapid Access Addiction Clinic at St. Paul’s, said he beat an addiction to alcohol and cocaine and understands there’s a small window of opportunity to get people into treatment, often after they’ve had a wake-up call from an overdose.

“If they have the opportunity to get on Suboxone right away that will help. If they have to wait 10 hours to come to a clinic or just to wait to get treatment a lot of things can happen. A lot of things can happen in a couple of hours, when people get another fix.”

Drug users often fear getting treatment because they face stigma as “low-life addicts,” even from medical staff, though that’s been slowly changing as addiction has become better understood, Haggerty said.

Dr. Keith Ahamad, the other co-lead of the program, said the overdose crisis demands a change in emergency-room culture in order to save lives and handing people a prescription is the wrong approach.

“Many places don’t even do that, which is kind of shocking,” said Ahamad, who is also a researcher with the BC Centre on Substance Use.

“We’re in the midle of a public health emergency and it really needs to be all hands on deck. If there were any other health emergency like this emergency departments really would be the beacon of where to get care. They’re open 24/7 and they’re staffed with all sorts of health-care professionals,” he said.

“The culture around addiction treatment in the health-care system for decades has really been one of ignore. And if we do anything the onus is on the patient to try and navigate a system and find care somewhere and maybe we give them a number to call and they’re told on a certain day within a few weeks they can maybe make an appointment somewhere.”

— Follow @CamilleBains1 on Twitter.

Camille Bains, The Canadian Press

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RCMP seeks names of potential victims of coerced sterilization, Lucki says

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OTTAWA — The RCMP is seeking the names of potential victims of coerced sterilization procedures and wants lawyers to help in the process, RCMP Commissioner Brenda Lucki said Tuesday.

In testimony before the House of Commons health committee, Lucki said the RCMP is willing to meet with victims, adding it would be helpful if lawyers could talk to complainants about coming forward.

“The lawyers … if they were to speak with those victims and provide them the options of coming to the police, we would absolutely sit down with each and every victim that they had to look at it from a criminal point of view,” she said.

“Obviously they are not going to release their names without their consent as well. But … if we were to have those conversations, and possibly we could convince victims to come forward through the lawyers, that would be one avenue that we could explore.”

MPs asked Lucki to testify as part of a study about ongoing concerns from predominantly Indigenous women who allege they were coerced or forced into tubal ligation procedures during childbirth.

Her testimony also followed a letter sent this spring by NDP health critic Don Davies who asked the RCMP to conduct an investigation of serious and credible allegations that have been brought forward.

Lucki told Davies in a March letter that the force would work with commanding officers in each province and territory as well as other police agencies to see if any complaints have been reported.

“To date, we have no allegations that are on file for forced or coerced sterilization that were found to be reported to the RCMP directly,” Lucki said Tuesday. She said the RCMP takes all criminal allegations very seriously and that the force has reached out to the Canadian Association of Chiefs of Police to raise awareness.

The issue has been the subject of much public scrutiny, particularly in the past two years.

In 2017, the Saskatchewan Health Region issued a public apology after complaints from Indigenous women, and a proposed class-action lawsuit was launched naming as defendants the Saskatoon Health Authority, the provincial and federal governments, and a handful of medical professionals.

Dr. Judith Bartlett, a Metis physician who co-authored the external review, told the committee on Tuesday that Indigenous women interviewed for the report often felt invisible, profiled and powerless.

She also said she does not believe women will come forward to the RCMP because there is “no safety there for them.” Those interviewed for the report were granted anonymity, she said, noting they often felt much better having been able to express the harm done to them.

Much more research is needed to understand the scope of the problem because any time an individual is asked to make a decision when they’re not in the state of mind to weigh pros and cons constitutes coercion, Bartlett said.

Dr. Jennifer Blake, chief executive of the Society of Obstetricians and Gynaecologists of Canada, told MPs that obtaining consent for tubal ligations at the time of delivery should be avoided at all costs. She also noted that when she first learned of allegations a forced sterilizations, she thought it was in reference to a historical issue.

Last Tuesday, lawyer Alisa Lombard, a partner with the firm Semaganis Worme Lombard, told the health committee she represents a client, referred to as D.D.S., was sterilized without proper and informed consent in December 2018 at a Moose Jaw, Sask., hospital

That same month, the United Nations Committee Against Torture urged Canada to act to address the issue of coerced sterilization, setting a one-year deadline to report back on progress.

In response, Health Minister Ginette Petitpas Taylor and Jane Philpott, then Indigenous services minister, sent a letter to provinces and territories proposing a working group of officials to discuss the concerns.

Health Canada said Tuesday the group has had “productive discussions” about the scope and purpose of the federal-provincial-territorial plan to “advance cultural safety and humility in the health system.” As a first step, officials decided Health Canada would take the lead on “an environmental scan of cultural safety initiatives and practices across Canada,” the agency said in a statement.

—Follow @kkirkup on Twitter

Kristy Kirkup, The Canadian Press

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Blair says more gun-control action needed, signals no new steps before election

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OTTAWA — Crime Reduction Minister Bill Blair says more must be done to address gun violence, but he’s also signalling that no new measures will be taken before the fall election.

Steps could — and should — be taken to prevent the theft, illegal diversion and cross-border smuggling of handguns, Blair said Tuesday. 

As he entered a cabinet meeting, Blair emphasized the importance of secure storage of firearms to prevent them from being stolen and ending up in the wrong hands.

The government is also open to working with municipalities to allow them to decide exactly where, or even if, firearms can be stored within their boundaries, he said.

However, the parliamentary sitting is expected to conclude shortly and the government is scrambling to tie up loose ends before the summer recess and an election campaign likely to begin in September.  

“Some of this would require regulatory and legislative change,” Blair said. “And I think it’s important not only to do the right thing, but to take the time to do it right.”

Prime Minister Justin Trudeau asked Blair last August to study the possibility of a ban on handguns and assault-style rifles after a shooting spree in Toronto.

A recently released summary of a federal consultation said Canadians were divided on the idea.

Still, Blair’s office said late last month that no options had been ruled out to clamp down on guns “designed to hunt people” as it weighed new options. Rumours of a federal ban on the popular AR-15 semi-automatic rifle began to circulate.

While Blair reiterated Tuesday there are firearms the government considers “so dangerous that there really is no place in a safe and civil society for them,” he made no firm commitment to ban or buy back such guns from owners.

Blair stressed a need to ensure secure storage, prevent people from buying firearms on behalf of criminals and deter smuggling of weapons into Canada from the United States, which he called “the largest handgun arsenal in the world.”

“There are a number of very effective measures that I believe that we can and must take to create a safer environment.”

Allowing municipalities to enact additional restrictions on handguns would not only be “wholly inadequate,” it would also be inefficient, said Heidi Rathjen, co-ordinator of PolySeSouvient, which wants an overhaul of the gun classification system with the ultimate aim of banning weapons specifically designed to kill people.

“All one has to do is consider the glaring disaster resulting from a patchwork of state and local gun laws south of the border,” she said Tuesday.

“And one has to ask: why would stricter controls on handguns be justified in cities and not in rural areas? It seems more like the Liberals chose not to deal with the highly politicized issue of banning handguns and instead decided to pass the buck to municipalities.”

The law already requires safe storage of firearms, but there has been a “significant increase” in the theft of large numbers of handguns from homes and retailers, with the guns ending up on the street in the wrong hands, Blair said.

He acknowledged there are responsible handgun owners who obey all the rules. “We may ask them to undertake additional measures to secure their weapons to make sure that they’re not vulnerable to being stolen.”

Public Safety Canada says 24 firearms were stolen from a shop in Prince Albert, Sask., by snipping one cable, raising concerns that the after-hours commercial storage regulations could be insufficient.

Some businesses “may not be fully compliant” with existing regulations, say department notes released through the Access to Information Act. However, chief firearms officers “indicate this is infrequent and businesses come into compliance quickly when non-compliance is identified.”

The RCMP says some businesses go beyond minimum requirements through measures including shatterproof glass in display cases, video-monitoring systems and alarms, safes bolted to the floor, deadbolt locks and solid doors instead of hollow ones for storage rooms.

— Follow @JimBronskill on Twitter

Jim Bronskill , The Canadian Press


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